mTBI/Concussion Flashcards
What are 4 red flag symptoms for can individual with a concussion?
- Focal neurological signs
- Mass effect
- Symptoms with a crescendo
- Symptom progression
If a concussion is suspected, what are the 7 components of a physical exam which should be done?
- Cognitive (MMSE, mini-cog)
- Vitals
- EENT
- CNs
- Gait and balance (BESS, Berg Balance Assessment)
- Peripheral NS (sensory, motor, reflexes)
- Autonomic NS
What 5 questions can help rule out red flags in the history when assessing a concussion?
- Was there head trauma?
- Was there LOC?
- Is there amnesia?
- Are there focal deficits/long tract signs?
- Are any drugs/alcohol involved?
What is Dejerine’s triad?
Worsening symptoms on coughing/sneezing/beniding
Symptom of increasing intracranial pressure
True or false: increased intracranial pressure is associated with bilateral headaches and vomiting with nausea
False - without nausea
In which positio would you expect an individual with increased intracranial pressure to have increased symptoms: seated or supine?
Supine
What is the cushing triad?
signs that are indicative of increased intracranial pressure (ICP)
Includes HTN, braycardia, and respiratory depression
Cheyne-Stokes respiration (rapid breathing followed by absent breathing) is associated with which type of head injury?
A) Supratentorial
B) Infratentorial
A
Infratentorial injury is associated with which type of breathing A) Hyperventilation B) Hypoventilation C) Cheyne-Stokes respiration D) Kussmaul's respitation
A
Which is a better prognostic factor for a concussion: moving pain or static pain?
Moving pain (ie. the location of the pain changes day-to-day)
The acute care phase of concussion recovery phase should involve frequent _____________ and ___________ rest
Physical; cognitive
Concussion symptoms are considered unresolved when they last for more than _____ weeks
3
S&S of a grade 2 concussion
Normal consciousness Confusion No post-traumatic amnesia Unsteadiness/dizziness- Tinnitus Headache Symptoms last over 15 minutes Difficulty concentrating Recurring headaches Irritability Signs and symptoms may last several weeks
What are 2 high risk flags after a concussion?
High blood pressure
Poor concentration
What are 2 indications that neurological follow-up and neuropsychological interventions are needed after a concussion?
- Signs of affective symptoms (symptomatic sleep disruption, anxiety/depression, behavioural changes)
- Signs of unresolved functional symptoms (concentration, reading, listening to music, fears of busy/noisy environments)
What is the SCAT5 used for?
On-field assessments of concussions
Can be used in-clinic too
Can also be used preseason to obtain baseline
True or false: SCAT5 can be used to make a diagnosis of concussion
False - only a screening tool
What are the red flags for concussion according to the SCAT5?
Neck pain/tenderness Double vision Weakness or tingling/burning in arms/legs Severe/increasing headache Seizure/convulsion LOC Deteriorating conscious state Vomiting Increasingly restless/agitated/combatative
In a patient who is not lucid or fully conscious, a _______________ injury should be assumed until proven otherwise
Cervical spine
What are Maddocks questions?
- Which ground/ field/rink are we playing at?
- Which team are we playing today?
- Which half/quarter/period is it?
- How far into the game is it?
- Which side scored last?
- Which team did we play last game?
- Did we win last game?
What are the key diffences between the SCAT5 and the child SCAT5?
Maddock’s questions are modified
Child’s report of symptoms obtained using child-specific symptom scale
Parent’s rating of child’s symptoms is obtains
Orientation testing is simplified (no time of day)
Concentration test simplified (start with 2 reverse digits, reverse days of week)
Modified BESS test (no single-leg stance)
Patient provided advice on return to school (not play) protocol
